Provider Demographics
NPI:1235569567
Name:BLAIR, KASON RICARDO (RPH)
Entity Type:Individual
Prefix:MR
First Name:KASON
Middle Name:RICARDO
Last Name:BLAIR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NE PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909
Mailing Address - Country:US
Mailing Address - Phone:239-242-2231
Mailing Address - Fax:239-242-2235
Practice Address - Street 1:4 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909
Practice Address - Country:US
Practice Address - Phone:239-242-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist